1/4. Simultaneous reconstruction of the area of the temporo-mandibular joint including the ramus of the mandible in a posttraumatic case. A case report.A new technique for the simultaneous reconstruction of the glenoid fossa and the ramus of the mandible is described. By combining and adapting procedures already described, the missing bone of the zygomatic arch, temporo-mandibular joint and ramus was replaced in one operation in a post-traumatic case. The indication for this operation is discussed. It is rather limited. The technique can be used for reconstruction of skeletal defects after tumour resection and in congenital aplasias of this region.- - - - - - - - - - ranking = 1keywords = post-traumatic (Clic here for more details about this article) |
2/4. hyperbaric oxygenation as a successful therapeutic approach in oral wound dehiscence after operative stabilization of an unstable post-traumatic odontoid non-union.The non-operative treatment of unstable traumatic Anderson's type II odontoid fractures has a high risk potential to develop non-unions. Even after operative stabilization literature reveals non-union rates up to 20%. Acute life threatening complications are tetraplegia and apnoea. Long-term complications induce chronic myelopathy resulting from persistent myeloradicular compression. We report the case of a patient with a 17-year-old post-traumatic pseudarthrosis of the dens axis following conservative treatment of an unstable type II fracture. By that time, the female patient, then 37 years old, was admitted to our hospital with early signs of cervical tetraplegia. After initial reposition and short-term immobilization with a halothoracic vest we performed a ventrodorsal atlantoaxial spondylodesis. Failure of anterior cervical plate stabilization and autologous graft resorption without a solid segmental fusion instigated a secondary surgical intervention. Postoperative therapy-resistant oral wound dehiscence showed an exposed autograft and osteosynthetic material. The reported positive effect of hyperbaric oxygenation on wound healing in problem cases led us to attempt this means of therapy. With a daily exposure to hyperbaric oxygenation, the dehiscence closed within 25 days. As a result of our experience in this case, hyperbaric oxygenation should be considered as a therapeutic option in postoperative complication management in orthopaedic surgery.- - - - - - - - - - ranking = 5keywords = post-traumatic (Clic here for more details about this article) |
3/4. Primary post-traumatic mandibular reconstruction in infancy: a 10-year follow-up.Ballistic trauma to the craniofacial skeleton combines the challenges of complex bone injury and loss with severe soft tissue injury and violation of the naso-orbital or oropharyngeal cavities. The authors report a patient who experienced a unique ballistic injury at 28 months of age that resulted in loss of the mandibular ramus and condyle. A segmental injury to the facial nerve was also identified. Primary costochondral grafting and delayed interpositional nerve grafting was undertaken. After 10 years, the patient has nearly 40 mm of opening, with only slight deviation to the injured side. Her facial nerve regeneration provides complete orbicularis oculi function, oral competence, and only slight facial asymmetry. This traumatic reconstruction differs from that of patients with hemifacial microsomia or post-traumatic/arthritic ankylosis in that the joint space itself was spared. Thus, the costochondral graft benefits from the remaining articular disk and upper disk space and is able to rotate and translate. Function and growth are adequately re-established, even in this young pediatric patient.- - - - - - - - - - ranking = 5keywords = post-traumatic (Clic here for more details about this article) |
4/4. Cranial bone grafts for post-traumatic facial defects.Recent interest in onlay cranial bone grafts has shown it to be a preferred technique in the reconstruction of facial defects. This paper reports seven patients in whom outer table cranial bone grafts were used to reconstruct post-traumatic facial deformities. These included orbital and zygomatic deformities (2 patients), maxillary defects (2 patients), mandibular defects (2 patients), and nasal deformity (1 patient). A brief review of the development of membranous bone grafting for maxillofacial reconstruction is given. Good cosmetic results were obtained in six of seven patients with no evidence of graft resorption. One patient required removal of the graft because of inadequate soft tissue coverage. No patient suffered any significant donor site morbidity. In summary, this technique is extremely useful in treating post-traumatic bony deformities of the facial skeleton. The excellent graft survival and ease in harvesting the graft make this technique preferable to traditional endochondral grafts taken from the iliac crest and rib.- - - - - - - - - - ranking = 6keywords = post-traumatic (Clic here for more details about this article) |